I am one of Peter Hartmann's PhD students and would like to add to Joy's
comments regarding the research being undertaken by Peter and his students.
Peter has expressed to me in conversation two concerns regarding the use of
the terms hindmilk and foremilk.

One is certainly reflected by all that Joy has explained in her previous
post. Another problem  relates to the quantum leap that has been made by
many between the research findings and how these affect clinical practice.
Many people emphasise the importance of the baby accessing "hindmilk" at
each feed because they assume that the so called "fat rich hindmilk" at each
feed is what the baby requires for adequate growth. However two
considerations are important: one is that  fat transferred to the baby is
related to many, many factors. Seventy percent, however, of the variability
of fat transfer is due to the degree of fullness of the breast and the
length of time since the last feed. It is therefore much more appropriate to
consider fat transfer over a 24 hour period rather than being hung up on
making sure the baby gets "hindmilk" at each feed.

The second factor is the assumption made that the growth of the infant is
dependent on how much "hindmilk" or fat is transferred to the baby. In fact
infant growth is correlated to the volume of milk taken by the baby. This
has been published previously (sorry have no ref available to hand, but will
get for those interested) and work done by another of Peter's students that
is now being written up for publication confirms this. He has also shown
that there is great variation between mothers in the amount of fat in milk
transferred to their infants. Not only is there a large variation but his
research has not found a correlation between the amount of fat taken by
infants and their growth.

I think we all need to be very careful how we all extrapolate research
findings to clinical practice. Assumptions that may appear to make perfect
sense are perhaps not always "truth".

Cathy Fetherston
RM MSc IBCLC
Western Autralia

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